Basic Information
Provider Information
NPI: 1003800764
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TURNER
FirstName: MICHAEL
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 885
Address2:  
City: ABBEVILLE
State: SC
PostalCode: 296200885
CountryCode: US
TelephoneNumber: 8643666060
FaxNumber: 8644595719
Practice Location
Address1: 901 W GREENWOOD ST
Address2: SUITE 8-A
City: ABBEVILLE
State: SC
PostalCode: 296205678
CountryCode: US
TelephoneNumber: 8643666060
FaxNumber: 8644595719
Other Information
ProviderEnumerationDate: 09/08/2005
LastUpdateDate: 08/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X8413SCY Allopathic & Osteopathic PhysiciansUrology 

ID Information
IDTypeStateIssuerDescription
08413405SC MEDICAID
CC583001SCRAILROAD MEDICAREOTHER


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